A possible move to privatize certain Medicaid services for the vulnerable continues to draw scrutiny in states across the country, including Nevada.
Similar attempts have failed in at least one state in the past, and at least one other state is currently struggling.
At least 102 people, including state employees, voiced strong opinions during a public session on Wednesday night in Clark County.
Concerns expressed ranged from quality of care to disruption in services to potential job impacts among state employee.
"In reality, privatization often fails," said Harry J. Schiffman, president of the American Federation of State, County and Municipal Employees, local 4041.
The public meeting was the first in Southern Nevada to give community members the opportunity to provide feedback on a potential move that state officials are exploring, and could lead to delivery of Medicaid services for the elderly, blind and disabled through managed care.
Earlier this month, state officials in a closed-door meeting assured advocates that any process would move slowly and will be transparent.
This issue drew concerns from the beginning when legislation was introduced during last spring's legislative session with the public, and those directly impacted by the potential switch from state to private management of the services, knowing little about it. The original legislation died, but the concept survived after quietly being grafted onto a different bill right before the Legislature adjourned.
Similar measures were approved last year by lawmakers in other states, such as Oklahoma, where advocates hope the legislation will be repealed during this year's legislative session, which begins Feb. 1. Among the several driving factors pushing for privatization of all or certain Medicaid services in various states is to lower costs.
Iowa has also made headlines for its rush to privatize Medicaid services without being completely ready.
The number of Medicaid recipients has increased across the nation, including in Nevada, where many more became eligible under the Medicaid expansion under the Affordable Care Act. The total number of Medicaid recipients in the Silver State as of December was 608,790. Advocates have estimated that about 50,000 elderly, blind and disabled could be affected by the potential switch to managed care.
The state's total Medicaid budget for fiscal year 2016 is more than $3 billion.
Nevada already has contracts with two managed care organizations for Medicaid services, but not for the three vulnerable populations.
Barbara Paulsen, leader with Nevadans for the Common Good, a broad-based coalition of institutions in Las Vegas area advocating for several issues including those affecting senior citizens, said there are "concerns about the services being provided by for-profit organizations."
Schuffman said his union is against privatizing state services, period. There's also a lot of unknown in terms of whether state jobs would be affected.
"They cannot provide the same kind of care," he said of the managed care organizations. For state employees, "this is their careers, serving some of the most vulnerable in the state."
State officials plan to have meetings with state employees to hear their concerns and input.
"The department intends to be transparent not only with stakeholders and consumers and providers, but with the state workforce as well," Chrystal Main, spokeswoman for the state's Department of Health and Human Services, said Thursday.
The current services for some of those in the three vulnerable groups — elderly, blind and disabled — are already compromised, said Pauline Oehlman, with Nevadans for the Common Good.
As of last fall, there were 1,415 vulnerable people waiting to receive services through the Medicaid waivers to continue to live independently. But state officials said it would take $40.3 million to eliminate the backlog. People who receive services through the waivers are just a portion of the state's total elderly, blind and disabled Medicaid population.
"I think we need to do some house cleaning," Oehlman said.
Jane Gruner, administrator for Nevada's aging and disability services division, said officials will look at what's working and what's not working in the current system. Any possible changes will be thoroughly reviewed.
"We are committed to getting it right," she said after the meeting Wednesday.
Lawmakers in Oklahoma last year passed legislation to provide Medicaid services to the same Medicaid population — elderly, blind and disabled — through managed care, said Trish Emig, an aging advocate and member of several boards in the state.
In the late 1990s, a similar model was implemented in the state and couldn't be sustained, she said.
"There continues to be some push-back from providers and concerned consumers," Emig said Thursday. "I'm hopeful that it will be repealed in this legislative session."
In Iowa, officials with the federal Centers for Medicare and Medicaid Services intervened over the quick implementation, citing "significant concerns that the implementation time-frames for the transition to managed care may place access, continuity of care, and quality of care for beneficiaries at risk," according to a letter from federal officials to Iowa officials.
The implementation there has been delayed.